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- Title
Restorative Proctocolectomy in Elderly IBD Patients: A Multicentre Comparative Study on Safety and Efficacy.
- Authors
Colombo, Francesco; Sahami, Saloomeh; de Buck Van Overstraeten, Antony; Tulchinsky, Hagit; Mege, Diane; Dotan, Iris; Foschi, Diego; Leo, Cosimo Alex; Warusavitarne, Janindra; D’Hoore, André; Panis, Yves; Bemelman, Willem; Sampietro, Gianluca M.
- Abstract
Background and Aims: Restorative proctocolectomy in elderly inflammatory bowel disease [ IBD] patients is controversial and limited data are available on the outcomes of surgery. The aim of this study was to evaluate the safety, efficacy, and long-term results of ileal-pouch-anal anastomosis in elderly patients, in a multicentre survey from European referral centres. Methods: The International Pouch Database [IPD] combined 101 variables. Patients aged ≥ 65 years were matched on the basis of open versus laparoscopic surgery with a control group of consecutive younger unselected patients with a ratio of 1:2. Statistical analysis was performed using two-tailed t test, chi square and Fisher’s exact tests, Kaplan-Meier function, and log-rank tests where appropriate. Results: In the IPD, 77 patients aged ≥ 65 years [Group A] and 154 control patients [Group B] were identified. Elderly patients had more comorbidities [p = 0.0001], longer disease duration [p = 0.001], less extensive disease [p = 0.006], more previous abdominal operations [p = 0.0006], surgery for cancer or dysplasia more frequently [p = 0.0001], fewer single-stage procedures [p = 0.03], more diversions after ileal pouch-anal anastomosis [IPAA] [p = 0.05], and a higher laparoscopic conversion rate [p = 0.04]. Postoperative complications and pouch failure were similar between the groups, but Group A had more Clavien-Dindo IV-V complications [p = 0.04], and longer length of stay [p = 0.007]. Laparoscopy was associated with a shorter duration of surgery [p = 0.0001], and length of stay [p = 0.0001], and the same complication rate as open surgery. Conclusions: Restorative proctocolectomy can be performed in selected elderly patients, but there is a higher risk of postoperative complications and longer length of stay in this group. Laparoscopy is associated with shorter operating time and length of stay.
- Publication
Journal of Crohn's & Colitis, 2017, Vol 11, Issue 6, p671
- ISSN
1873-9946
- Publication type
Article
- DOI
10.1093/ecco-jcc/jjw209